Retrospective study on the Delta Shock Index associated with age and the Glasgow Coma Score (dSIAG) as a prognostic scale for mortality in polytrauma patients

Abstract

Introduction

This study aims to analyze differences between the prognostic scales in the initial assessment of severe trauma, SIAG ((Shock Index × Age)/Glasgow Coma Scale) upon arrival at the hospital and at the scene of the trauma (dSIAG). It has been compared with other prognostic scales, including the Shock Index (SI), RTS (Revised Trauma Score) and ISS (Injury Severity Score), given that these scales may underestimate the risk of mortality in some polytrauma patients.

Methods

We have conducted a retrospective, observational study with a cohort of patients admitted to the Critical Care Unit of a tertiary center with a diagnosis of trauma from 2018−2020. The SI, dSI, SIAG, dSIAG, RTS and ISS scales were calculated. The AUC-ROC (area under the receiver operating characteristic curve) of each one was compared for M24 (mortality in the first 24 h) and HM (hospital mortality).

Results

Out of the 113 patients included, 11 died (9.7%), 9 in the first 24 h (8%). All scores were related to mortality. The dSIAG had the best AUC-ROC for M24 (0.88; 95%CI 0.80−0.96) and MH (0.84; 95%CI 0.71−0.96), although the results between dSIAG and SIAG were similar. The dSIAG value of 0.3 points showed a sensitivity of 77% and specificity of 78% for HM and 89% and 77% for M24. The AUC-ROC of the dSIAG for HM was higher than the classic RTS and ISS scores.

Conclusion

The dSIAG is similar to the SIAG and higher than the classic ISS and RTS scores as a predictor of HM in the initial assessment of polytrauma patients.